Monday, November 30, 2015

Fewer minority children receive ADHD diagnosis

Minority children were less likely than their white counterparts to be diagnosed with ADHD, which means less access to programs and medications to treat the disorder. What can parents do?

Fewer minority children receive ADHD diagnosis


Minority children were less likely than their white counterparts to be diagnosed with attention-deficit/hyperactivity disorder, found a study in the July 2013 issue of Pediatrics published online today.

From a nationally representative group of 15,100 children who entered kindergarten in the fall of 1998, the odds were 46 percent lower for children of other ethnicities, 50 percent lower for Hispanic children, and 69 percent lower for black children. Of this group, 780 children were diagnosed with ADHD by eighth grade.

Factors increasing children’s risk of an ADHD diagnosis included being a boy, children who had mothers age 38 or older at the child’s birth, being raised in an English-speaking household, and engaging in behaviors such as fighting, arguing with a teacher, and acting impulsively.

The researchers found that disparities in ADHD diagnosis begin in kindergarten and continue until at least eighth grade. Children who are undiagnosed don’t have access to help such as specialized learning programs and medication that can lessen the disorder’s impact. Among children diagnosed with ADHD, medication use was also lower for all minority children. The study does not address if whites may be overdiagnosed for ADHD.

study can't say, however, whether the differences mean that ADHD is being underdiagnosed in minorities or overdiagnosed in whites. Previous research has raised both possibilities.
study can't say, however, whether the differences mean that ADHD is being underdiagnosed in minorities or overdiagnosed in whites. Previous research has raised both possibilities.

We asked study author Paul L. Morgan, Ph.D. an associate professor, department of educational psychology, counseling, and special education; director, educational risk initiative; research affiliate, Population Research Institute; and faculty affiliate, Child Study Center at the Pennsylvania State University to tell us more about the results and what minorities parents can do if they suspect their child has ADHD.

Why do you suspect this is happening?

We're unable to say with these data why minority children are comparatively under-diagnosed for ADHD. Other researchers have hypothesized or found that these disparities may be occurring in part due to lower access to health professionals and, when seen, less frequent solicitations by these professionals of developmental concerns for the children. Cultural or language barriers may also play a part, as well as negative attitudes towards disability identification in some racial/ethnic subcultures.

What are the disparities that can occur and why is this a concern?

The disparities can occur in both diagnosis and treatment. One of our main findings is that these disparities are evident as early as kindergarten, and continue to occur throughout elementary and middle school. These disparities are a concern because they mean that minority children who in fact have ADHD may not be receiving a diagnosis and so accessing effective treatment for their disorder. Prior research has reported on a number of effective treatments for ADHD, including medication, cognitive-behavioral therapy, and parent training.

Even for those with a diagnosis, why do fewer minorities use medication?

Unfortunately, our study can't answer this. However, our study does find that minorities children are reported to be less likely to be using mediation, and that this disparity in treatment is not explained by a range of factors, including differences in academic achievement or behavioral functioning, socioeconomic status, and health insurance coverage.

What are the signs parents should be looking for with ADHD?

Here are some helpful Websites:

The National Institute of Mental Health: ADHD

Centers for Disease Control and Prevention: ADHD

United States Department of Education: ADHD

The study calls for increased awareness and questioning by health care providers, school psychologists and teachers to ensure minority children receive appropriate diagnosis. What can parents do if they suspect their child has ADHD? 

Parents who are concerned with their child's behavior in regards to paying attention should bring these concerns to school personnel or their pediatrician to make sure that their child is being appropriately evaluated. ADHD is considered a chronic condition, but one that can respond well to treatment. Helping ensure that minority children with ADHD are being appropriately diagnosed and treated for the disorder should result in better school-based functioning and adjustment, particularly as children age.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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